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Peripheral Arterial DiseaseINITIATENCT04042311

High Intensity Interval Training In pATiEnts With Intermittent Claudication

A study testing High-intensity interval training in people with Peripheral Arterial Disease and Intermittent Claudication, run by Hull University Teaching Hospitals NHS Trust at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This INITIATE study evaluates the use of high-intensity interval training as a treatment modality for patients with intermittent claudication - an ambulatory leg pain caused by narrowed arteries that supply the lower limbs. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
High-intensity interval training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
70 participants
Where
1 siteUnited Kingdom
Study dates
15 Jun 2018to 4 Jul 2022
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged >18 years
  • Ankle-brachial pressure index (ABPI) <0.9 at rest or a systolic pressure drop of ≥20mmHg at the ankle after exercise testing
  • Ability to walk unaided
  • English speaking and able to comply with exercise instructions
  • Aged >18 years
  • ABPI <0.9 at rest or a systolic pressure drop of ≥20mmHg at the ankle after exercise testing
  • Ability to walk unaided
  • English speaking and able to comply with exercise instructions

Who cannot join

  • Unable to provide informed consent
  • Critical limb threatening ischaemia / rest pain / tissue loss
  • Active cancer treatment
  • Significant comorbidities precluding safe participation in exercise testing and / or training according to the American College of Sports Medicine (ACSM) guidelines (28)
  • Resting/uncontrolled tachycardia (>100 beats per minute [bpm]) and/or resting/uncontrolled hypertension (systolic blood pressure >180 millimetres of mercury [mmHg] or diastolic blood pressure >100mmHg)
  • Symptomatic hypotension
Show all 20Show fewer
  • Additional exclusion criteria:
  • Following baseline cardiopulmonary exercise test (CPET), patients will be withdrawn and prevented from continuing their involvement in the study if there is any evidence of:
  • Exercise-induced myocardial ischaemia or significant haemodynamic compromise (manifesting as anginal symptoms, significant ECG changes or an abnormal blood pressure response).
  • An inability to complete a maximal effort CPET
  • Workstream 2:
  • Unable to provide informed consent
  • Critical limb threatening ischaemia / rest pain / tissue loss
  • Active cancer treatment
  • Significant comorbidities precluding safe participation in exercise testing and / or training according to the American College of Sports Medicine (ACSM) guidelines (28)
  • Resting/uncontrolled tachycardia (>100bpm) and/or resting/uncontrolled hypertension (systolic blood pressure >180mmHg or diastolic blood pressure >100mmHg)
  • Symptomatic hypotension
  • Additional exclusion criteria:
  • Following baseline CPET, patients will be withdrawn and prevented from continuing their involvement in the study if there is any evidence of:
  • ● Exercise-induced myocardial ischaemia or significant haemodynamic compromise (manifesting as anginal symptoms, significant ECG changes or an abnormal blood pressure response).

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Academic Vascular Surgical Unit, Vascular Dept. 1st Floor Tower Block

    Hull, HU3 2JZ

Other trials in United Kingdom

About this study

Official title: High Intensity Interval Training In pATiEnts With Intermittent Claudication (INITIATE): a Proof-of-concept Prospective Cohort Study to Assess Acceptability, Feasibility and Potential Clinical Efficacy

This INITIATE study evaluates the use of high-intensity interval training as a treatment modality for patients with intermittent claudication - an ambulatory leg pain caused by narrowed arteries that supply the lower limbs.

It is an observational cohort study considering high-intensity interval training (HIIT) as a treatment for intermittent claudication, consisting of two workstreams. Workstream 1: an initial observational cohort study to consider the feasibility of the intervention and exclusion criteria. Workstream 2: a proof of concept study utilising the altered intervention and exclusion criteria following recommendations highlighted during workstream 1.

Read the detailed description

Patients with peripheral vascular disease (PVD) may develop a reproducible pain in their legs when they walk, which usually subsides with rest. This is known as intermittent claudication (IC) and is caused by a reduced blood supply to the legs as a result of narrowed or hardened arteries that supply the lower limbs. This ambulatory pain impedes on activities of daily living, functional capacity and quality of life.

National Institute for Health and Care Excellence (NICE) clinical guidance recommends a 12-week supervised exercise programme as first-line treatment for IC, whereby patients are encouraged to walk to the point of maximal pain. Robust clinical trials have demonstrated that supervised exercise programmes are efficacious for improving both pain-free and maximal walking distances, whilst also potentially improving quality of life.

Despite this, supervised exercise programmes are vastly under-utilised and not always available to consultant vascular surgeons. This means that further programmes need to be developed in order to provide a range of options to patients to improve uptake and adherence rates. One such programme is a 6-week high-intensity interval training programme.

An initial observational cohort study of the 6 week HIIT programme will be conducted to determine to determine the feasibility of the intervention and inclusion criteria. The results from this will be used to make any necessary changes to the HIIT intervention before moving into a proof of concept study, considering the utility, safety, acceptability and potential clinical efficacy of this programme.

Being tested
High-intensity interval training
Keywords
Exercise, High-intensity interval training, interval training
Medical subject headings
Peripheral Arterial Disease, Intermittent Claudication, Motor Activity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • High-intensity interval trainingOther

    a high-intensity interval training programme completed 3 times a week for 6 weeks using a stationary Wattbike.

Study groups in NCT04042311
Study groupRoleWhat they receive
High-Intensity interval training (workstream 1)ExperimentalHigh-intensity interval training performed for 20 minutes, 3 times weekly for a period of 6 weeks at 85-100% of maximal heart rate.
Receives: Other: High-intensity interval training

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Tolerability Test - Related Withdrawals

    Defined by examining the number of withdrawals related to the intervention or study procedures (i.e. patients unable to tolerate).

    Measured: From the first to last exercise session, i.e. from week 0 to week 6.

  2. Feasibility Test

    Feasibility measures included the number of patients screened vs. the number eligible, the number of patients eligible vs. the number recruited and the number recruited vs. the number completed.

    Measured: From study opening to completion/withdrawal of the last patient

  3. Tolerability Test - Achieving the Required Intensity

    Considers the patients ability to achieve and maintain exercise at the appropriate intensity for the duration of each session

    Measured: From the first to last exercise session, i.e. from week 0 to week 6.

  4. Tolerability Test - Number of Sessions Completed

    Considers the number of sessions completed compared to the theoretical number.

    Measured: From the first to last exercise session, i.e. from week 0 to week 6.

  5. Tolerability Test - Number of HIIT Intervals Completed

    Considers the number of HIIT intervals completed compared to the theoretical number.

    Measured: From the first to last exercise session, i.e. from week 0 to week 6.

Secondary outcomes (12)
  1. Safety Events Recorded

    Defined as the occurrence of any adverse or serious adverse events related to the intervention.

    Measured: From enrolment to completion of 12-week follow-up

  2. Acceptability Testing

    An evaluation of the acceptability of the exercise intervention assessed by patient feedback, using semi-structured interviews.

    Measured: post-intervention follow-up, i.e. week 6.

  3. Maximum Walking Distance

    assessment of the distance that the patient can currently walk before having to stop due to claudication pain.

    Measured: Baseline, post-intervention (week 6), then 4 weeks (week 10) and 12 weeks (week 18) post-intervention.

  4. Peak Oxygen Uptake

    Peak oxygen uptake assessed via cardiopulmonary exercise testing

    Measured: Baseline, post-intervention (week 6), then 4 weeks (week 10) and 12 weeks (week 18) post-intervention.

  5. Quality of Life Questionnaire Short-form-36 (SF-36)

    Patient reported quality of life using the SF-36 SF-36 is a 36-Item Short Form Health Survey questionnaire. It consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability.

    Measured: Baseline and post-intervention (week 6)

  6. Vascular Quality of Life Questionnaire - (VascuQol)

    VascuQoL includes 25 items subdivided into 5 domains and a sum score is also calculated by dividing the total score by 25.

    Each domain and the total score range from 1 to 7 with 1 representing the worst score and 7 the best.

    Measured: Baseline and post-intervention (week 6) follow-up

  7. Ankle-Brachial Pressure Index

    The index or ratio of the pressure in the ankle compared with the arm.

    Measured: Baseline, post-intervention (week 6), then 4 weeks (week 10) and 12 weeks (week 18) post-intervention.

  8. Peak Power Output

    Peak power output assessed via CPET

    Measured: Baseline, post-intervention (week 6), then 4 weeks (week 10) and 12 weeks (week 18) post-intervention.

  9. Pain-free Walking Distance

    assessment of the distance that the patient can currently walk before experiencing claudication pain.

    Measured: Baseline, post-intervention (week 6), then 4 weeks (week 10) and 12 weeks (week 18) post-intervention.

  10. Ventilatory Anaerobic Threshold (VAT)

    Ventilatory anaerobic threshold assessed via cardiopulmonary exercise testing

    Measured: Baseline, post-intervention (week 6), then 4 weeks (week 10) and 12 weeks (week 18) post-intervention.

  11. Quality of Life Questionnaire Short-form-36 (SF-36)

    Patient reported quality of life using the SF-36 SF-36 is a 36-Item Short Form Health Survey questionnaire. It consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability.

    Measured: 4 weeks (week 10) and 12 weeks (week 18) post-intervention

  12. Vascular Quality of Life Questionnaire - (VascuQol)

    VascuQoL includes 25 items subdivided into 5 domains and a sum score is also calculated by dividing the total score by 25.

    Each domain and the total score range from 1 to 7 with 1 representing the worst score and 7 the best.

    Measured: 4 weeks (week 10) and 12 weeks (week 18) post-intervention.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Aug 2019
  2. Study start15 Jun 2018
  3. Primary completion4 Apr 2022
  4. Study completion4 Jul 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Workstream 1: An initial single group cohort of 30 patients will be recruited and analysed to refine/alter the intervention and exclusion criteria based on its feasibility. Workstream 2: This altered intervention and inclusion criteria will be considered in a further proof of concept study which will be multi-centre aiming to recruit a further x40 patients.
Masking
None (open label)
Enrolment
70 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04042311
Sponsor's protocol ID
R2219
Acronym
INITIATE
Status last verified
Sep 2024
First submitted
11 Jul 2019
Last updated
14 Nov 2024
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Pymer S, Harwood AE, Ibeggazene S, McGregor G, Huang C, Nicholls AR, Ingle L, Long J, Rooms M, Chetter IC, Twiddy M. High INtensity Interval Training in pATiEnts with Intermittent Claudication: A Qualitative Acceptability Study. Ann Vasc Surg. 2024 May;102:17-24. doi: 10.1016/j.avsg.2023.11.043. Epub 2024 Jan 30.

    PubMed 38301846
  • Pymer S, Harwood AE, Prosser J, Waddell A, Rhavindhran B, Ibeggazene S, McGregor G, Huang C, Twiddy M, Nicholls AR, Ingle L, Carroll S, He H, Long J, Rooms M, Chetter IC. High-intensity interval training in patients with intermittent claudication. J Vasc Surg. 2023 Oct;78(4):1048-1056.e4. doi: 10.1016/j.jvs.2023.05.045. Epub 2023 Jun 16.

    PubMed 37330704
  • Pymer S, Ibeggazene S, Palmer J, Smith GE, Harwood AE, Carroll S, Ingle L, Chetter IC. Considering the Feasibility, Tolerability, and Safety of High-Intensity Interval Training as a Novel Treatment for Patients With Intermittent Claudication. J Cardiopulm Rehabil Prev. 2021 May 1;41(3):188-193. doi: 10.1097/HCR.0000000000000551.

    PubMed 33186201
  • Pymer S, Harwood A, Ibeggazene S, McGregor G, Huang C, Twiddy M, Nicholls AR, Ingle L, Carroll S, Long J, Rooms M, Chetter IC; INITIATE investigator group. High INtensity Interval Training In pATiEnts with intermittent claudication (INITIATE): protocol for a multicentre, proof-of-concept, prospective interventional study. BMJ Open. 2020 Jul 6;10(7):e038825. doi: 10.1136/bmjopen-2020-038825.

    PubMed 32636290

Questions about this trial

What is this clinical trial studying?

A study testing High-intensity interval training in people with Peripheral Arterial Disease and Intermittent Claudication, run by Hull University Teaching Hospitals NHS Trust at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 14 Nov 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Tolerability Test - Related Withdrawals (time frame: From the first to last exercise session, i.e. from week 0 to week 6.). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04042311, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Nov 2024.

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